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Breast Imaging-Reporting and Data System (BI-RADS) classification in 51 excised palpable pediatric breast masses
Jeffrey L Koning1, Katherine P Davenport2, Patricia S Poole3
1Department of Radiology, University of California San Diego, 200 West Arbor Drive MC 8756, San Diego, CA 92103-8756, United States.
Insights
The Breast Imaging Reporting and Data System (BI-RADS) classification may not accurately assess malignancy risk in pediatric breast masses. In this study, all BI-RADS 4 lesions in children were benign, suggesting potential overestimation of risk.
Area of Science:
- Radiology
- Pediatric Surgery
- Oncology
Background:
- The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) is used for breast lesion risk stratification.
- Previous BI-RADS validation studies have not included pediatric populations.
- Pediatric breast masses often present as palpable lesions and are evaluated with ultrasound, frequently receiving a BI-RADS classification.
Purpose of the Study:
- To correlate BI-RADS classifications with histopathological findings in pediatric breast masses.
- To assess the applicability and accuracy of the BI-RADS classification system in pediatric patients.
Main Methods:
- Retrospective review of pediatric patients (n=105) who underwent breast mass excision from July 2010 to November 2013.
- Analysis of preoperative ultrasound BI-RADS classifications (n=51) and correlation with surgical pathology.
- Inclusion of demographic data and imaging results.
Main Results:
- 119 palpable masses were excised from 105 pediatric patients.
- Of 51 masses with BI-RADS classification, all were in female patients (average age 15.9 years).
- 25 masses (49%) were classified as BI-RADS 4, and 100% of these demonstrated benign pathology, most commonly fibroadenoma.
Conclusions:
- The BI-RADS classification may not be a valid treatment algorithm for pediatric breast lesions.
- BI-RADS 4 classification in pediatric patients in this cohort did not correlate with malignancy.
- Further large-scale studies are needed to validate BI-RADS in pediatric and adolescent populations to avoid overstating malignancy risk or the need for biopsy.
Introduction:
The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) classification was developed to risk stratify breast lesions and guide surgical management based on imaging. Previous studies validating BI-RADS for US do not include pediatric patients. Most pediatric breast masses present as palpable lesions and frequently undergo ultrasound, which is often accompanied with a BI-RADS classification. Our study aimed to correlate BI-RADS with pathology findings to assess applicability of the classification system to pediatric patients.
Methods:
We performed a retrospective review of all patients who underwent excision of a breast mass at a single center from July 2010 to November 2013. We identified all patients who underwent preoperative ultrasound with BI-RADS classification. Demographic data, imaging results, and surgical pathology were analyzed and correlated.
Results:
A total of 119 palpable masses were excised from 105 pediatric patients during the study period. Of 119 masses, 81 had preoperative ultrasound, and BI-RADS categories were given to 51 masses. Of these 51, all patients were female and the average age was 15.9 years. BI-RADS 4 was given to 25 of 51 masses (49%), and 100% of these lesions had benign pathology, the most common being fibroadenoma.
Conclusions:
Treatment algorithm based on BI-RADS classification may not be valid in pediatric patients. In this study, all patients with a BI-RADS 4 lesion had benign pathology. BI-RADS classification may overstate the risk of malignancy or need for biopsy in this population. Further validation of BI-RADS classification with large scale studies is needed in pediatric and adolescent patients.
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